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The Impact of Endoscopic Retrograde Cholangiopancreaticography on Length of Stay
388
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
it is sometimes difficult to grasp a global anatomic image due to the limited scope field during the laparoscopic gastrectomy, dual-phase 3D CT angiography is useful and essential modality to visualize precise anatomy around stomach preoperatively and to perform safety treatment.
contrast, surgeon happiness with staff/equipment had only a fair correlation with self-rated overall happiness on the Oxford scale. The self-rated calmness domain (R2 ¼ 0.87) had an excellent correlation with happiness with staff/equipment while all other domains did not correlate well. Conclusions: Surgeon self-rated conscientiousness and calmness was strongly associated with level of happiness with operative conduct and level of happiness with staff/equipment. Self-rated neuroticism had a moderate inverse relationship with surgeon happiness with staff/equipment. Surgeon self-rated overall happiness correlated well with surgeon happiness with operative conduct. Surgeon self-perception and personality influence their feelings about operative conduct. Differences in personality may account for some of the variability in measures of surgeon happiness at the completion of an operation. 54.17. The Impact of Endoscopic Retrograde Cholangiopancreaticography on Length of Stay. R. C. Britt, T. Novosel, L. Weireter, S. F. Reed, J. N. Collins, L. Britt; Eastern Virginia Medical School, Norfolk, VA
54.16. Happiness with Operative Conduct Correlates Self-Rates Surgeon Personality Characteristics. Knoll, J. J. Stulberg, B. Champagne, H. Reynolds, Jr, Delaney, E. L. Marderstein; University Hospitals Medical Center, Cleveland, OH
with P. A. C. P. Case
Introduction: Scales to predict postoperative complications are generally derived from easy to measure preoperative laboratory values and intraoperative conduct is given insufficient weight. While subjective ratings by surgeons of their happiness with operative conduct for an individual operation may predict the likelihood of a postoperative complication, individual surgeon personality may strongly affect these measures. The purpose of this study was to demonstrate the effect of surgeon personality on happiness with operative conduct. Methods: As part of an ongoing study of postoperative complications, the 4 surgeons in the Division of Colorectal Surgery are asked to rate their level of happiness with operative conduct and their level of happiness with staff/equipment at the conclusion of each surgical procedure. Personality testing was performed using the validated instruments: Big Five Inventory Version 54 and the Oxford Happiness Questionnaire. Correlation was performed between the postoperative ratings and the personality testing. Results: Surgeon happiness with operative conduct was recorded for a cohort of 131 patients and averaged 7.8 out of 10. Surgeon happiness with staff/equipment averaged 8.1 out of 10. As expected for the Big Five Inventory, surgeons self-rated highest on the scale for conscientiousness (mean 4.4 of 5) and slightly lower on the scales for extraversion, agreeableness, openness and neuroticism (3.5-3.8 of 5). Surgeon happiness with operative conduct correlated best with their self-rated conscientiousness (R2 ¼ 0.65) but there was no correlation with the other personality domains. Surgeon happiness with staff/equipment also correlated well with their self-rated conscientiousness (R2 ¼ 0.95) and inversely with self-rated neuroticism (R2 ¼ 0.60) but did not correlate with the other domains. Surgeon happiness with operative conduct correlated well with self-rated overall happiness on the Oxford scale (R2 ¼ 0.62). Within the domains of this scale, self-rated life satisfaction (R2 ¼ 0.81) and calmness (R2 ¼ 0.85) showed particularly robust correlation with surgeon happiness with operative conduct. By
Background: Endoscopic retrograde cholangiopancreaticography (ERCP) performed either before or after laparoscopic cholecystectomy (LC) is a commonly used modality for the management of choledocholithiasis. We assess the impact of pre and post-operative ERCP on length of stay. Methods: A retrospective review was done of a prospectively collected database encompassing all patients with biliary disease admitted to the Acute Care Surgery Service over two years. Diagnosis, operations performed, time from admission to operation, length of stay (LOS), and complications were assessed. Results: 190 patients with biliary disease were operated on, with 22 having preop ERCP and 26 postop. There was no difference in the age or co morbidities between the three groups. The patients who did not require ERCP had a significantly shorter LOS (4.9 vs 9.1 days, p < 0.0001) as well as a significantly shorter time from admission to operation (55.3 vs. 84.3 hours, p < 0.01). There was no significant difference in the LOS for the pre versus postoperative ERCP groups (8.6 vs. 9.6 days, p ¼ 0.75), but the post-operative ERCP group had a significantly shorter time for admission to operation (64.6 vs. 106.6 hours, p < 0.02). No patients had an unsuccessful post-operative ERCP. 34 of the 142 patients who did not need ERCP had a negative intraoperative cholangiogram, with three patients having choledocholithiasis on cholangiogram treated with laparoscopic common bile duct exploration and clearance. The 37 patients who had intraoperative cholangiogram did have a significantly shorter LOS (5.3 vs 9.1, p < 0.04) and a trend towards shorter time from admission to operation (67.6 vs. 84.3 hours, p ¼ 0.25) than the patients requiring ERCP. Conclusion: The need for ERCP significantly lengthens hospital length of stay and time from admission to operation. An appropriate treatment algorithm for suscepted choledocholithiasis may be laparoscopic cholecystectomy with intraoperative cholangiogram and possible attempt at laparoscopic stone clearance, followed by judicious use of ERCP as necessary. 54.18. Laparoscopic Cholecystectomy Conversion Rates Two Decades Later: An Analysis of Surgeon and PatientSpecific Factors Resulting in Open Conversion. S. V. Sakpal, S. S. Bindra, C. Paruthi, R. S. Chamberlain; Saint Barnabas Medical Center, Livingston, NJ Background: Although we are more than two decades into the laparoscopic era, nationwide laparoscopic cholecystectomy (LC) conversion rates remain in excess of 10% in some series.1 We sought to analyze patient-specific features in converted LCs, and determine the impact of surgeon-specific factors on conversions. Methods: A total of 2,205 LCs (74.7% female and 25.3% males; average age of 50.5 years [range 1-96]) performed at a large tertiary community hospital over a 5-year period (May 2004-October 2008) were analyzed retrospectively. Results: The overall conversion rate for the study period was 4.94%. The number of cholecystectomies peaked
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
it is sometimes difficult to grasp a global anatomic image due to the limited scope field during the laparoscopic gastrectomy, dual-phase 3D CT angiography is useful and essential modality to visualize precise anatomy around stomach preoperatively and to perform safety treatment.
contrast, surgeon happiness with staff/equipment had only a fair correlation with self-rated overall happiness on the Oxford scale. The self-rated calmness domain (R2 ¼ 0.87) had an excellent correlation with happiness with staff/equipment while all other domains did not correlate well. Conclusions: Surgeon self-rated conscientiousness and calmness was strongly associated with level of happiness with operative conduct and level of happiness with staff/equipment. Self-rated neuroticism had a moderate inverse relationship with surgeon happiness with staff/equipment. Surgeon self-rated overall happiness correlated well with surgeon happiness with operative conduct. Surgeon self-perception and personality influence their feelings about operative conduct. Differences in personality may account for some of the variability in measures of surgeon happiness at the completion of an operation. 54.17. The Impact of Endoscopic Retrograde Cholangiopancreaticography on Length of Stay. R. C. Britt, T. Novosel, L. Weireter, S. F. Reed, J. N. Collins, L. Britt; Eastern Virginia Medical School, Norfolk, VA
54.16. Happiness with Operative Conduct Correlates Self-Rates Surgeon Personality Characteristics. Knoll, J. J. Stulberg, B. Champagne, H. Reynolds, Jr, Delaney, E. L. Marderstein; University Hospitals Medical Center, Cleveland, OH
with P. A. C. P. Case
Introduction: Scales to predict postoperative complications are generally derived from easy to measure preoperative laboratory values and intraoperative conduct is given insufficient weight. While subjective ratings by surgeons of their happiness with operative conduct for an individual operation may predict the likelihood of a postoperative complication, individual surgeon personality may strongly affect these measures. The purpose of this study was to demonstrate the effect of surgeon personality on happiness with operative conduct. Methods: As part of an ongoing study of postoperative complications, the 4 surgeons in the Division of Colorectal Surgery are asked to rate their level of happiness with operative conduct and their level of happiness with staff/equipment at the conclusion of each surgical procedure. Personality testing was performed using the validated instruments: Big Five Inventory Version 54 and the Oxford Happiness Questionnaire. Correlation was performed between the postoperative ratings and the personality testing. Results: Surgeon happiness with operative conduct was recorded for a cohort of 131 patients and averaged 7.8 out of 10. Surgeon happiness with staff/equipment averaged 8.1 out of 10. As expected for the Big Five Inventory, surgeons self-rated highest on the scale for conscientiousness (mean 4.4 of 5) and slightly lower on the scales for extraversion, agreeableness, openness and neuroticism (3.5-3.8 of 5). Surgeon happiness with operative conduct correlated best with their self-rated conscientiousness (R2 ¼ 0.65) but there was no correlation with the other personality domains. Surgeon happiness with staff/equipment also correlated well with their self-rated conscientiousness (R2 ¼ 0.95) and inversely with self-rated neuroticism (R2 ¼ 0.60) but did not correlate with the other domains. Surgeon happiness with operative conduct correlated well with self-rated overall happiness on the Oxford scale (R2 ¼ 0.62). Within the domains of this scale, self-rated life satisfaction (R2 ¼ 0.81) and calmness (R2 ¼ 0.85) showed particularly robust correlation with surgeon happiness with operative conduct. By
Background: Endoscopic retrograde cholangiopancreaticography (ERCP) performed either before or after laparoscopic cholecystectomy (LC) is a commonly used modality for the management of choledocholithiasis. We assess the impact of pre and post-operative ERCP on length of stay. Methods: A retrospective review was done of a prospectively collected database encompassing all patients with biliary disease admitted to the Acute Care Surgery Service over two years. Diagnosis, operations performed, time from admission to operation, length of stay (LOS), and complications were assessed. Results: 190 patients with biliary disease were operated on, with 22 having preop ERCP and 26 postop. There was no difference in the age or co morbidities between the three groups. The patients who did not require ERCP had a significantly shorter LOS (4.9 vs 9.1 days, p < 0.0001) as well as a significantly shorter time from admission to operation (55.3 vs. 84.3 hours, p < 0.01). There was no significant difference in the LOS for the pre versus postoperative ERCP groups (8.6 vs. 9.6 days, p ¼ 0.75), but the post-operative ERCP group had a significantly shorter time for admission to operation (64.6 vs. 106.6 hours, p < 0.02). No patients had an unsuccessful post-operative ERCP. 34 of the 142 patients who did not need ERCP had a negative intraoperative cholangiogram, with three patients having choledocholithiasis on cholangiogram treated with laparoscopic common bile duct exploration and clearance. The 37 patients who had intraoperative cholangiogram did have a significantly shorter LOS (5.3 vs 9.1, p < 0.04) and a trend towards shorter time from admission to operation (67.6 vs. 84.3 hours, p ¼ 0.25) than the patients requiring ERCP. Conclusion: The need for ERCP significantly lengthens hospital length of stay and time from admission to operation. An appropriate treatment algorithm for suscepted choledocholithiasis may be laparoscopic cholecystectomy with intraoperative cholangiogram and possible attempt at laparoscopic stone clearance, followed by judicious use of ERCP as necessary. 54.18. Laparoscopic Cholecystectomy Conversion Rates Two Decades Later: An Analysis of Surgeon and PatientSpecific Factors Resulting in Open Conversion. S. V. Sakpal, S. S. Bindra, C. Paruthi, R. S. Chamberlain; Saint Barnabas Medical Center, Livingston, NJ Background: Although we are more than two decades into the laparoscopic era, nationwide laparoscopic cholecystectomy (LC) conversion rates remain in excess of 10% in some series.1 We sought to analyze patient-specific features in converted LCs, and determine the impact of surgeon-specific factors on conversions. Methods: A total of 2,205 LCs (74.7% female and 25.3% males; average age of 50.5 years [range 1-96]) performed at a large tertiary community hospital over a 5-year period (May 2004-October 2008) were analyzed retrospectively. Results: The overall conversion rate for the study period was 4.94%. The number of cholecystectomies peaked